Economics Working Papers (2002–2016) Economics 9-29-2014 Perfecting beauty under the knife: the determinants of global cosmetic surgery consumption John C. Beghin Iowa State University, [email protected] Yalem Teshome Iowa State University, [email protected] Follow this and additional works at: http://lib.dr.iastate.edu/econ_las_workingpapers Part of the Economics Commons Recommended Citation Beghin, John C. and Teshome, Yalem, "Perfecting beauty under the knife: the determinants of global cosmetic surgery consumption" (2014). Economics Working Papers (2002–2016). 27. http://lib.dr.iastate.edu/econ_las_workingpapers/27 This Working Paper is brought to you for free and open access by the Economics at Iowa State University Digital Repository. It has been accepted for inclusion in Economics Working Papers (2002–2016) by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. Perfecting beauty under the knife: the determinants of global cosmetic surgery consumption Abstract We investigate major conjectures regarding the prevalence of cosmetic surgical procedures and their determinants, using a quantitative multidisciplinary approach and a recent international dataset from the International Society of Aesthetic Plastic Surgeons. Cosmetic surgery predominantly concerns women. The highest frequencies found in Greece, Italy, Korea, and Brazil fall short of epidemic proportions at less than 0.6% of their population. However, consistent with idealized stereotypes reported in the media and the social science literature, a few procedures dominate the composition of surgical interventions and focus on thinning bodies and reshaping breasts. Culture and geography count. We identify Latin and Neo-Confucian cultural effects associated with higher frequencies of surgical procedures. Beyond the Latin effect, a large positive geographical effect persists in Latin-American countries. Economic globalization is positively associated with the higher frequencies of procedures. Gender roles matter. Women reduce their consumption of procedures as they increasingly participate in the labor force and when they are more equally represented politically. Lower fertility increases the consumption. Finally, consumption increases with increasing income and greater availability of surgical services. Keywords cosmetic surgery, epidemic, global patterns, beauty, lipoplasty, breast augmentation, gender role, globalization Disciplines Economics This working paper is available at Iowa State University Digital Repository: http://lib.dr.iastate.edu/econ_las_workingpapers/27 Perfecting Beauty under the Knife: The Determinants of Global Cosmetic Surgery Consumption John C. Beghin, Yalem Teshome Working Paper No. 14017 August 2014 IOWA STATE UNIVERSITY Department of Economics Ames, Iowa, 50011-1070 Iowa State University does not discriminate on the basis of race, color, age, religion, national origin, sexual orientation, gender identity, genetic information, sex, marital status, disability, or status as a U.S. veteran. Inquiries can be directed to the Director of Equal Opportunity and Compliance, 3280 Beardshear Hall, (515) 294-7612. Perfecting Beauty under the Knife: The Determinants of Global Cosmetic Surgery Consumption This version: September 29, 2014 John C. Beghin (Economics, Iowa State University) Yalem Teshome (Anthropology, and Women’s and Gender studies, Iowa State University)* Abstract: We investigate major conjectures regarding the prevalence of cosmetic surgical procedures and their determinants, using a quantitative multidisciplinary approach and a recent international dataset from the International Society of Aesthetic Plastic Surgeons. Cosmetic surgery predominantly concerns women. The highest frequencies found in Greece, Italy, Korea, and Brazil fall short of epidemic proportions at less than 0.6% of their population. However, consistent with idealized stereotypes reported in the media and the social science literature, a few procedures dominate the global composition of surgical interventions and focus on thinning bodies and reshaping breasts. Culture and geography count. We identify Latin and modern Neo- Confucian cultural effects associated with higher frequencies of surgical procedures. Beyond the Latin effect, a large positive geographical effect persists in Latin-American countries. Economic globalization is positively associated with the higher frequencies of procedures. Gender roles matter. Women reduce their consumption of procedures as they increasingly participate in the labor force and when they are more equally represented politically. Lower fertility increases the consumption. Finally, consumption increases with increasing income and greater availability of surgical services. Keywords: Cosmetic surgery, epidemic, global patterns, beauty, lipoplasty, breast augmentation, gender role, globalization JEL Code: Z10, Z13, J16, F60 Contact author: Beghin. 260 Heady Hall. ISU. Ames IA 50011-1070. [email protected]. *We thank Otavio Bartalotti, Peter Orazem, Clark Wolf, and participants at the Human Resource Economics workshop and the Women’s and Gender studies brownbag workshop series at Iowa State University and the 2014 Humanities Education and Research Association (HERA) Annual Meetings for comments and discussions. The usual disclaimer applies. Perfecting Beauty under the Knife: The Determinants of Global Cosmetic Surgery Consumption …He saw my complications And he mirrored me back simplified And we laughed how our perfection Would always be denied … Joni Mitchell. Refuge of the Roads Introduction There has been a considerable debate on the global spread of cosmetic surgery. From Brazil to South Korea, China and Scandinavia, the media has reported a significant increase in various cosmetic procedures, especially surgical procedures (Chalk; Stone; and Watts, for example). Non-surgical procedures are also on the rise but exhaustive data are harder to find because many nonsurgical procedures take place outside of cosmetic surgeons’ practices and are undertaken by dermatologists and nonphysician practices (Brody et al.). In this paper, we focus on the surgical component of this emergence of cosmetic procedures and its international context. Many conjectures and alleged causes of this global spread have been advanced in the media and in the academic literature as explained below. To our knowledge we provide the first rigorous quantitative investigation of these conjectures and alleged causes focusing on surgical cosmetic procedures in a global comparative context. Cosmetic surgery mostly concerns women (ISAPS, 2014). Believing that it is an exercise in patriarchal power which controls and “medicalizes” women’s bodies, some feminist scholars (e.g., Bordo; Bartky) have argued against cosmetic surgery while others view it as an opportunity for choice in which women could empower themselves (Gimlin) and be more competitive in labor markets or in securing a higher-earning mate in marriage (Elliott). Men also increasingly resort to cosmetic surgery but to a much lower extent than women. They represent 14% of the total surgical procedures and tend to specialize in a few specific procedure types such as penile 1 implant and hair restoration (Elliott; ISAPS, 2014). A similar point has been made earlier about returns to beauty and labor and marriage outcomes (Hamermesh and Briddle) but without considering improvements in beauty although the two arguments are perfectly consistent. While we acknowledge the points highlighted and argued by social theorists, we accept the premise that cosmetic surgery consumption is by and large a female consumption. We empirically explore this consumption to sort out its global patterns and determinants. We rely on unique data collected by the International Society of Aesthetic Plastic Surgery (ISAPS), the major international professional association of cosmetic surgeons. The data are based on cosmetic surgeons’ surveys regarding major cosmetic surgical procedures these surgeons performed.1 The data collection is global. The data publicly available focus on the 25 largest countries by market size and an aggregate for the world, and for 19 major surgical procedures. Market size here means the total number of surgical procedures for these national markets for a set of 19 major surgical procedures. We investigate the patterns and structure of consumption of cosmetic surgery in these top 25 largest markets and an aggregate rest of the world (ROW) and for the 3 years of data (2009-11) that were available at the end of 2013. We explore various determinants of observed global patterns. When appropriately normalized by population (procedures per million people), the data provide substantial variation across many countries and over time spanning the Americas, Europe, Asia, and other regions. These variations are then explained statistically using regression techniques. Our investigation links the consumption of cosmetic surgical procedures per million people2 to various determinants, including indicators of geography, culture, globalization, gender roles, and economic factors. We investigate a series of conjectures about cosmetic surgical procedures 1We focus on surgical procedures because the ISAPS nonsurgical procedures data undercount the consumption of nonsurgical procedures undertaken outside cosmetic surgeons’ practices. 2 The normalization (per capita or million people) does not affect the statistical results. 2 advanced in the popular press and